Access to High-Volume Hospitals for High-Risk Cancer Surgery for Racial and Ethnic Minoritized Groups.

Abstract

High-volume hospitals have been associated with better outcomes for high-risk cancer surgeries, although concerns exist concerning inequitable access to these high-volume hospitals. We assessed tendencies in access to high-volume hospitals for 4 (lung, pancreatic, rectal, esophageal) high-risk cancer surgeries for Black and Hispanic patients in the National Cancer Database. Hospitals were classified as high volume according to Leapfrog Group volume thresholds. Odds of accessing high-volume hospitals increased over time for Black and Hispanic patients for 3 surgeries, but Black patients had lower probabilities of undergoing a pancreatectomy, proctectomy, or esophagectomy at high-volume hospitals than non-Black patients (eg, 2016 pancreatectomy rate: 49.0% [95% confidence interval (CI) = 45.4% to 52.5%] vs 62.3% [95% CI = 61.1% to 63.5%]). Although for Hispanics the gap narrowed for lung resection and pancreatectomy, these populations continued to have lower probabilities of accessing high-volume hospitals than non-Hispanic patients (eg, 2016 pancreatectomy: 48.8% [95% CI = 44.1% to 53.5%] vs 61.6% [95% CI = 60.5% to 62.8%]). Despite increased access to high-volume hospitals for high-risk cancer surgeries, ongoing efforts to improve equity in access are needed.